As doctors we are always observing the standards and quality of care in a hospital when we visit a relative admiited to that hospital. This observation becomes even more acute when you yourself get admitted as a patient. This is so all over the world. When a doctor has worked in a hospital in the West or in USA, he becomes even more aware of how a hospital is run as the staff working in those hospitals have to maintain certain prescribed standards that is monitored continuously.

I read a post written by Dr. Abha Agarwal in Docplexus, an Indian Medical Forum where he narrates his personal experience when he was admitted to a very reputable corporate hospital in India. Read the post and ponder about all that he has said. We do not expect the Govt. Hospitals in India to provide the type of care that we see in the West. However I thought the very expensive corporate hospitals did provide the same standards of care as the west. Is that not true?

Personal Experience At An Indian Hospital

"I was recently hospitalized for 4 days at a highly reputed brand name corporate hospital in India for a benign, self-limiting illness. Health-wise, I am fine now. However, I was deeply saddened with the state of basic processes and protocols in such an expensive and prestigious hospital. Here are some observations:

I opted for a high-end expensive private room. The bed mattress was badly damaged and torn in the center. Not only was it deeply uncomfortable for me, it is a major breech of infection control processes. I wonder how their bed mattresses are in general wards. Many times, the bed-sheets had visible and embarrassing holes in them.

A number of nurses, duty doctors, dietitian etc. visited me. NO ONE (except the charge nurse on the morning after admission) introduced themselves.

I never received a physical examination even though this was a full regular admission. Except for the regular readings of blood pressure, pulse and pulse ox, none ever bothered to take my temperature. I was receiving normal saline at a high rate, no one ever bothered to auscultate my lungs for fluid overload. Of course, there was no conversation about intake and output measures. No wearing of gloves during blood drawing or IV insertion. Heck, not even hand washing prior to IV insertion. The number of nurses will come during the day to change IV bags, change lines. NO ONE EVER EVER washed hands. So after one day, I started to bring it to their notice and gently asked if they can please use hand sanitizer before touching the IV. EVERY ONE of them gave me a look of contempt as they would give to someone whom they thought was being unduly demanding. One of them offered my hands are always clean. Another one, “ I just washed at nursing station”. It doesn’t matter that he touched 10 surfaces between that hand wash at nursing station and my IV line.

Once one of the IV caps fell on the floor. The young nurse promptly picked it up and put it right back on my IV line right in front of my eyes. She was so quick that I didn’t even have a chance to protest. When I complained, she was incredulous saying like whats the big deal, it was on the floor just for a moment.

Except for a couple of senior nurses on the floor, the junior ones, especially ones covering the night were very poorly trained. Finally, my last night, I gave up on complaining and trained her on IV tubing connections and we had a good time.

Every morning, beginning 6 AM, there were constant loud knocks on the door with loud and rude “May I come in” from assorted people. So it doesn’t matter that I wanted to rest, their onslaught was unstoppable even after I put out the “Do not disturb sign”. For example, one person will knock first to pick up water pitcher, then 5-7 min later when she brought back the water pitcher. When I refused to receive sponging at 6:15 AM, I was asked to sign my refusal. One person will come for mopping the floor; another security guy just to ensure that we have not sneaked in unnecessary attendants at night (as if my entire family was so desperate for a chance to sleep in a hospital room!).

Day of discharge, after long wait and multiple reminders, we received a bill which included dietitian consultation fee. When we told the billing clerk that no one ever came to see us and we don’t need one either, he said this is MANDATORY. And 10 min later, a clueless individual claiming to be a dietitian appeared in our room with a ‘diet chart’ of NO VALUE WHATSOEVER. I asked her how she could prepare a diet chart for me without ever knowing my height/weight/BMI, past medical history and WITHOUT ever talking to me. She was just ‘well this is what we have been told to do”.

Of course, the professional training and skill of the consulting physician was beyond reproach and the building of the hospital was nice and swanky with a nice gift shop and café in the lobby for a nice look. I am just sad and shocked. If this is the quality of healthcare delivered to an educated person who can well advocate and look out for oneself – a physician, at an expensive top brand name hospital in India, what is the state of affairs at lesser hospitals for a non-physician patient.

I have been reflecting on this experience. It's my observation that these hospitals are usually started by rock-star docs or big corporations who own them. They hire more rock-star doctors who really are well-skilled. But as I learned over decades of my healthcare leadership experience in the US, it is the nurses and ancillary staff that make or break the quality of healthcare and patient experience. These hospitals and corporations have well-meaning nurses and staff but ZERO PROFESSIONAL MANAGEMENT TO run the hospitals. I think the owners of these hospitals believe that once a building is erected, docs are in, staff are hired and patients start coming after big promo ads, the hospital should run by itself.

There are THOUSANDS OF DETAILS AND CLINICAL PROCESSES THAT REQUIRE DEDICATED, SKILLED PROFESSIONALS in C-SUITE AND MIDDLE MANAGEMENT. Such individuals don't exist in these hospitals. So poorly trained, poorly paid staff with no supervision, no systems just tries to do what they can. The reason for the absence of PROFESSIONAL MANAGEMENT is that this is 'non-revenue generating' OVERHEAD COST and is not considered necessary. Once the patient is in (through whatever means) and the bills have been done, who cares whether patient left satisfied or not. Even if they never come back, its an over-populous country and another sucker will occupy another bed and generate new revenue. Another thing I am intrigued about: this hospital, I assume is NABH-accredited. How could it be when such basic processes and protocols are missing? Does NABH accreditation not require a physical exam documentation on every patient? Do they not mandate basic infection control protocols like hand washing and intact surfaces such as mattresses? Do they not mandate ongoing training of staff such as nurses. A lot of questions have been raised in my mind from this experience. I welcome others' views."

Hi BadriIt is very interesting to read the narration of this doctor regarding the kind of treatment he had from a corporate hospital. But as I read it I could smell something mismatch in this write-up. I agree that the miserable condition of the bed and linen and other non medical facilities provided would have been par below the standard expected of from such hospitals. But if they keep the hospital in such a condition, do you think rich people would go there for a second time? In kerala it cannot happen. People are very choosy and I should say that most of these elite hospitals are kept in a very good condition. Leave alone the corporate hospitals, even small private hospitals are most of them are in fine shape. But both corporate hospitals and other private hospitals may fleece the patients out of proportion to the services rendered. That is a different thing. Another intriguing aspect of this story is that he has not mentioned about the nature of his illness which made him seek treatment from this hospital. Of course it is his private issue and we have no right to question him. But he had mentioned that no one in the hospital even auscultated his chest and at the same time he is in all praise for the efficiency of the physicians there. From his writing it looks that he is a senior experienced doctor. It does not look any acute emergency involving any cardio, respiratory or neuro systems. In that condition he would have been admitted in an ICU. He does not mention about it at all. Does not seem to have had any surgical condition also. Then why admission to a large corporate hospital for a senior doctor in the first place? If it is for a abscess in the back, no one will come and auscultate his chest daily. Sorry Badri. I might look very odd questioning the veracity of this narration.

Yes there are many things here that look odd. However we must look at a few things that he mentioned. Irrespective of what you are admitted for, when a patient is clerked in, a full assessment is necessary that includes listening to your chest, recording your BP and Pulse. Many a corporate hospital would rather do a CT/MRI scan than listen to the chest (even when they are admitted for a minor problem). The other thing that he reports is about antisepsis measures that must be taken seriously. How many doctors or nurses wash their hands before examining a second patient or before drawing blood or giving an infusion of IV fluids? Many don't.

I remember a patient here in UK who lodged a complaint about an ophthalmologist who did not wash his hands after the last patient and before he started to examine him!

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